Ganglion Cyst also called Synovial Cyst is a soft but firm cystic overgrowth usually found near joints and tendon sheaths.

APPEARANCE OF GANGLION CYST  AND ITS AMBIGUOUS NOMENCLATURE

SIZE AND SHAPE OF GANGLION CYST

It is somewhat round in shape well-demarcated margins and can grow upto 5cm in size. The average size is 2cm.

CONSISTENCY OF GANGLION CYST

Most of them have consistency that is seemingly hard but its fluid filled within so its best described as “Soft but Firm”. It is so, because though fluid filled the firm character is derived due to the wall of the cyst which is thin but tough and firm due to high tensile strenght of the wall and also it actually divides or breakes-off shoots at various points into many thin films which runs randomly into the depth of the cyst and each film of wall intermingling and interlacing with each other and forming a mesh work just like a complex knotty intermingled bunch of thread, this also turns larger cyst into collection of multiple small cysts within.

Due to this the term Ganglion was derived which actually meant “Knot Beneath Skin”.

It does have a larger cystic space within but rest of it is much of multiple very small cysts giving it hard and firmer character. the firmer the cyst more of the wall meshwork within. Softer Ganglion are more of fluid within and lesser wall meshwork.

LOCATIONS OF GANGLION CYST

They appear near almost any joints and tendon sheaths wether hands, feets, within knee joint near cruciate ligaments or hoffa’s infrapatellar fat pad, near shoulder joint where larger cysts apposing or adjoining each other have known to compress nerve within, acromioclavicular joint within gastroncemous muscle, biceps tendon, peroneal nerve sheath, it can rarely be intraosseous, it is also seen in popleteal artery from from within tunica adventia layer of the artery and such condition is not common but is termed as Cystic Adventitial Disease.

The most common site of it appearance is wrist joint, along the Extensor Carpi Radialis Brevis especially when it passes over wrist joint on dorsal aspect.It is also commonly found on fingers mostly near joints

They also appear on feet almost 40% lumps found on feet turn out to be Ganglion cyst but there are very rare chance of them appearing on soles and heels the reason may be because there is constant tapping of that region with floor and that was the old treatment to treat ganglion cyst that is to tap it with thick book like Bibble, that why it was also called “Bibble Cyst” in ancient times.

Ganglion cyst is a misnomer used since ancient times, remaining unchanged till date, making it ambiguous term which is not at all related in anyways to the neuronal ganglion or ganglion cell.

CAUSES OF GANGLION CYST

Herniation Hypothesis

Althought the exact cause of Ganglion Cyst is unknown but Herniation Hypothesis is being widely accepted. Herniation Hypothesis states that probable cause is thought to be due to weakened joint capsule which leads to distention and out-pouching.

The dye injected in joints space can enter the cyst but not vice a versa. This shows that though the joint space is some what continious in someways with cyst but with a Check-Valve Mechanism to prevent the cyst fluid entering into joint space. This oneway flow causes further bulging and herniation.

This hypothesis is supported by the fact that

• The fluid within the cyst is Mucinous which resembles to synovial fluid
• The microscopic anatomy of cyst resembles to that of tenosynovial tissue.
• The dye experiment that shows that Joint Space and Cyst are continuous but with unidirectional flow towards cyst

Other probable mechanisms and causes of Ganglion Cyst

• Joint stress leads to split in joint capsule that surrounds the joint, as a result the synovial fluid leaks into the tissue and create thicker cystic fluid with cyst wall
• They may occur when the connective tissue breaks down around a joint. They tend to attach to an underlying joint capsule or tendon sheath.
• Degenerative conditions of synovial joint post trauma or inflamation causes damage to proportion that body’s process of healing with primary patent intention becomes insufficient and body starts healing with secondary intention with compensatory mechanisms activated giving rise to abnormal joint capsule composition and malformed joint capsule linning making it more vulnerable and thus facilitating further damage over and over again and giving rise to ganglion.
• Excessive Hyaluronic acid secretion by fibroblasts
• Excessive proliferation of parenchymal cells
• Myxoid degeneration of fibroid tissues and liquifaction.

Occupation plays an imoprtant role in development of ganglion, occupations where workers overuse certain joints, example wrist have a tendency to develop ganglion.

SYMPTOMS OF GANGLION CYST

Most of the ganglion cause some pain usually following acute repeatative trauma but about 30 to 35 % are without symptoms except for their appearance.

If pain is present, it is usually chronic and is made worse by continous movement of joint.

The swelling may appear over time or when the cyst is connected to a tendon or nerve there is sense of weakness and numbness in the affected finger.
Stiffness and spasms of joints may occur.

DIAGNOSIS OF GANGLION CYST

Ganglion cyst can be diagnosed easily based on the appearance and location of the cyst.

A routine X-ray or ultrasound can help to rule out other serious outcomes.
X-ray wil be usually normal unless there are changes related to arthritis.

HOMOEOPATHIC APPROACH IN CASE OF GANGLION CYST

As from above we see Ganglion cyst is disease condition that triggered due to degeneration there is overgrowth but its triggered as a secondary compensatory mechamism  where the tissue is degenerated and not the regular one

So this condition falls primarily under Syphylitic condition with Sychotic secondary processes.

In such patients its of much importance to evaluate general constitution and find out any other degenerative condition that also shows simultaneous regenerative as features within itself.

If such conditions are found or any other constitutional or miasmatic deep seated conditions are found at more than one site (which is usually found in such cases on very thorough case taking) then they need to be evauated with their totality and constitutional or miasmatic treatment should be given.

There are many cases where its an isolated condition with no other strong miasmatic or constutional features supporting of that can be linked to th ganglion cyst in such cases initially starting theraputically yeilds some results and also helps vital principle to express new symptoms which then will help get the constitution properly during second prescription

It is difficult to cure the condition with theraputically indicated medicine alone. It does resolve the visible cyst to nonpalpable level but it will resurface again and again soon after the action duration of the given theraputic is over. And to anihilate ot from roots it will require a deep acting constitutional medicine sooner or later.

INDICATED REMEDIES IN GANGLION CYST

CALCAREA FLOUR

Calcarea flour  is indicated in hard, stony glands, ganglions, and enlargement of joints. Calcarea flour is very well indicated in ganglion or encysted tumours at the back of the wrist. The patient usually experienes pain while moving the joint. Calcrea flour disperses bony growth, exostosis after injury. The patient presents with general stiffness of joints with numbness of affected part. The patient is sensitive to cold, to change in weather.

CALCAREA CARB

This remedy has great affinity towards glands, bone and skin. Impaired nutrition being the keynote of its action. Cacarea is indicated in case of ganglion of wrist. Presents with sharp, stitching pain as if parts are wrenched or sprained. Patient presents with weakness of extremities and swelling of joints. Well suited in arthritic nososities. Patient is worse from exertion both mental or physical. Complaints Worse from cold in every form and better by dry weather.

RUTA GRAVEOLENS

Ruta is know for its sphere of action on periosteum and cartilages. It is seen that Ruta has tendency to form deposits in periosteum, tendons and joints especially wrist. Ruta is one of the indicated remedy in ganglion of wrist. Bones of wrist and back of hand are painful as if bruised. Pain while lifting heavy weight. Numbness and tingling in hand after exertion. Feeling of intense lassitude, weakness and despair. Ruta is well suited to mechanical injuries of bones and periosteum which may be one of the causative factor for ganglion.

BENZOIC ACID

Benzoic acid has affinity towards all the joints especially wrist, knees and there is cracking on motion. Benzoic acid is indicated in gouty or rheumatic diathesis engrafted on a syhilitic patient. Indicated in ganglion with swelling of wrist. There are Gouty deposits on both the wrists. Paralytic pains, pain on movement of joints. Patient is usually sad, weak, debilitated and inclined to dwell on unpleasant things.

SILICEA

Silicea has affinity towards diseases pf bones, caries and necrosis. Indicated in case of ganglion cyst on wrist. Patient presents with stitching type of pain with numbnesss in fingers. Tonic spasms of hand when writing. Profuse sweat of hand with ganglion on back of the hand. Weakness rigidity and want of flexibility in fingers. Usually the complaints develop slowly. Silicea is Adapted to nervous, irritable, sanguine temperament, dry pale skin. Very oversensitive both mentally and physically.

SULPHUR

Sulphur is a deep acting antipsoric remedy. Its action is centrifugal that is from within outwards. Sulphur is indicated in case of ganglion and rheumatic complaints. Ganglion on back of wrist. Sprained pain and stiffness of wrist, worse in the morning. Presents with Paralytic weakness of hands and arms. Rigidity and wrenching pain in joints. Trembling of hands when strained. Sulphur patient is usually quick tempered, lean with stoop shoulder.

ONE OF OUR CASES OF GANGLION CYST CURED WITH HOMEOPATHIC MEDICINES WITHOUT ANY SURGERY

BEFORE HOMEOPATHIC TREATMENT

AFTER HOMEOPATHIC TREATMENT